Harm Reduction Principles Research Articles

Towards Housing First and harm reduction: addressing opioid dependence and homelessness in Tshwane during the COVID-19 pandemic

Pandemics can increase mortality and drug-related harms among people experiencing homelessness. The Housing First approach prioritises housing and service access. Harm reduction, a principle of Housing First, minimises the consequences of drug use. This chapter presents lessons learnt from the application of Housing First and harm reduction principles with homeless people in Tshwane, South Africa, between April 2020 and March 2021. Quantitative service delivery data were retrospectively reviewed and analysed using descriptive statistics. Accounts by authors who participated in the COVID-19 response were collectively discussed in relation to the Housing First and harm reduction actors and process. Issues were synthesised in relation to two six-month periods. A task team was established to co-ordinate Tshwane’s response. In the first six months, 1 440 temporary bed-spaces were created at 25 shelters, and 2 066 people at shelters received food, social support and on-site healthcare services. Across shelters, 1 076 residents were started on methadone to manage opioid withdrawal. By the second six-month period, many gains were lost. Changes in political leadership stalled plans to reintegrate people housed in temporary shelters, and reduced funding led to shelter closures. By April 2021, more shelters operated than in pre- COVID-19 times, harm reduction capacitation for shelter staff continued, and local government committed to establish a street homelessness unit. Through a combination of funding and collaboration, progress was made towards Housing First and harm reduction for homeless people in Tshwane. A national policy on homelessness should be developed, funded and implemented. This should be informed by additional research, developed in partnership with affected populations, and built on a common understanding of Housing First and harm reduction.

Harm reduction readiness for illicit IV drug use among safety-net primary care practices in the San Fernando Valley

BackgroundHarm reduction is an accumulation of strategies aimed at preventing adverse health outcomes associated with illicit substance use. Several harm reduction programs and services exist within Los Angeles County (LAC), however their success relies in part on the application of harm reduction principles by local primary care providers serving patients with substance use disorders. This study aims to assess the readiness of patient-centered medical homes in the San Fernando Valley to provide effective harm reduction to patients who use injection drugs and identify barriers to doing so.MethodsAn online survey was distributed to primary care providers and social workers via email at federally qualified health centers and LAC Department of Health Services clinics in the San Fernando Valley between May and June 2019. It consisted of 22 multiple-choice, Likert scale, and short answer questions. The survey assessed knowledge of injection drug use (IDU), familiarity and utilization of harm-reduction and resources, and self-evaluation of attitudes and skills.ResultsThere were a total of 41 survey respondents across all clinics. Of respondents, 98% correctly identified heroin as a drug typically injected, and 93% identified Hepatitis C as an infectious risk of IDU. 63% of respondents use harm reduction strategies every few months or less. 34% prescribe buprenorphine routinely, and 76% prescribe pre-exposure prophylaxis to those at risk for Human Immunodeficiency Virus (HIV). 76% are comfortable discussing IDU with their patients, but 59% indicate that they lack the necessary skills, and 42% agree that they lack the time to address it.ConclusionKnowledge of IDU was adequate among those surveyed, although overall utilization of harm reduction was infrequent. There is a perceived deficit in skills and time to effectively provide harm reduction to primary care patients in the San Fernando Valley.

Drug Harm Reduction in Vietnam: A Review of Stakeholders' Perspectives and Implications for Future Interventions.

Objectives. To determine how harm reduction should be applied in low-resource countries such as Vietnam by exploring the perspectives of people who use drugs (PWUD), health care professionals, and policymakers regarding methadone treatment and harm reduction strategies. Methods. We conducted 2 qualitative studies in Vietnam between 2016 and 2021. We interviewed 62 PWUD and 22 experts in drug policy development and drug treatment programs, conducted observations at methadone clinics and harm reduction program meetings, and analyzed drug policy documents. Results. PWUD considered methadone treatment only as a transition to a drug-free life. Policymakers deemed harm reduction ineffective and continued to enforce arrest and incarceration of PWUD. Drug intervention programs are not yet geared to providing specialized services. Effective communication strategies and information on evidence-based harm reduction models are inadequate to help policymakers make the right decisions. Conclusions. Harm reduction principles have not been fully adopted in Vietnam. A harm reduction strategy based on a more humanistic approach that goes beyond a biomedicalized approach is urgently needed in Vietnam and other countries in the Global South. (Am J Public Health. 2022;112(S2):S182-S190. https://doi.org/10.2105/AJPH.2022.306764).

Does Treatment Readiness Shape Service-Design Preferences of Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Methamphetamine? A Cross Sectional Study.

Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex with men (gbMSM). However, not all gbMSM are interested in changing their substance use. The present study aimed to examine whether participant-preferred service characteristics were associated with their readiness to change. We surveyed gbMSM who used CM in the past six months, aged 18 plus years, on dating platforms. Participants rated service-design characteristics from “very unimportant” to “very important”. Multivariable regression tested service preference ratings across levels of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES-8D). Among 291 participants, 38.7% reported their CM use was not problematic, 19.5% were not ready to take any action to reduce or stop using CM, and 41.7% were ready to take action. On average, participants rated inclusive, culturally-appropriate, out-patient counselling-based interventions as most important. Participants with greater readiness-to-change scores rated characteristics higher than gbMSM with lesser readiness. Contingency management and non-abstinence programming were identified as characteristics that might engage those with lesser readiness. Services should account for differences in readiness-to-change. Programs that provide incentives and employ harm reduction principles are needed for individuals who may not be seeking to reduce or change their CM use.

Aging queer in a pandemic: intersectionalities and perceptions

PurposeThe purpose of this study is to highlight the experiences and issues of an overlooked demographic: older LGBTQ + adults in the US, in the context of the COVID-19 pandemic. This allows the authors to explore possible changes in policy and practice regarding the management of the pandemic with attention to elderly LGBTQ.Design/methodology/approachBuilding on the authors’ experience in disaster research and a study of older LGBTQ + adults in the San Francisco Bay Area, the authors analyze key trends in COVID-19 pandemic management while drawing lessons from the AIDS epidemic.FindingsThe authors have found that LGBTQ + people, especially older and transgender individuals, have unique experiences with hazards and public safety and healthcare professionals and organizations (e.g. heteronormative care, traumatic insensitivity, deprioritizing essential treatments as elective). Second, older LGBTQ + adults' perceptions of state responses to pandemics were heavily influenced by experiences with the HIV/AIDS pandemic. And third, experiences with the COVID-19 pandemic have important implications for preventing, responding to and recovering from future epidemics/pandemics.Originality/valueThe authors point to two parallel implications of this work. The first entails novel approaches to queering disaster prevention, response and recovery. And the second is to connect the management of the COVID-19 pandemic to the principles of harm reduction developed by grassroots organizations to suggest new ways to think about contagion and organize physical distancing, while still socializing to take care of people’s physical and mental health, especially the more marginalized like elderly LGBTQ + people.

Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study.

Background:The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization.Methods:We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods.Results:We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards.Interpretation:Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.

Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City.

BackgroundDespite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage to care. We implemented an HCV testing and patient navigation program at an adult probation department.MethodsAdults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a laboratory-based HCV ribonucleic acid (RNA) assay if anti-HCV positive. All individuals received counseling rooted in harm reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless the patient was lost to follow-up. Study participation involved an optional survey and optional point-of-care human immunodeficiency virus test.ResultsOf 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34 of 52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment, as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. One hundred ninety-three individuals tested for HIV; none tested positive.ConclusionsThe study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage to care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage to care could improve health in this population. Colocalization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

Harm Reduction Policing: An Evaluation of Law Enforcement Assisted Diversion (LEAD) in San Francisco

In 2017, San Francisco (SF) implemented Law Enforcement Assisted Diversion (LEAD), a program Beckett described as harm reduction policing. Through a process and outcome evaluation of LEAD SF, this paper demonstrates the positive impacts of harm reduction policing, on those who use drugs and/or engage in sex work. When law enforcement officers used their discretion to divert individuals into LEAD rather than arrest, those individuals had significantly fewer felony and misdemeanor arrests and felony cases, in comparison to a propensity score matched group. The focus group and interview data describe that the collaboration, the warm handoff, and LEAD’s harm reduction principles were mechanisms of success. However, obtaining officer buy-in was a key challenge. Despite that obstacle, LEAD SF’s harm reduction policing reduces offending, improves the wellbeing of people who use drugs and engage in sex work, and allows the police to carry out their mandate to protect and serve.

Low barrier perinatal psychiatric care for patients with substance use disorder: meeting patients across the perinatal continuum where they are

Pregnant and postpartum patients with substance use disorders (SUD) often have other co-occurring mental health disorders. Complications of substance use and mental health conditions, such as overdose and suicide, are a significant contributor to maternal morbidity and mortality. For individuals dually diagnosed with SUD and other mental health disorders, the perinatal period can be both a motivating and a vulnerable period for care. Barriers to optimal care include, but are not limited to, lack of screening, lack of referrals for care, a limited number of psychiatric providers available to care for pregnant patients, and stigma around mental health and addiction care in pregnancy. In this review, we discuss approaches to low-barrier perinatal psychiatric care for women with SUD to promote engagement in care. We review (1) appropriate psychiatric assessment and diagnostic work-up; (2) treatment planning incorporating shared-decision making, non-punitive and culturally sensitive patient-centred care, and principles of harm reduction with a focus on psychopharmacology, and (3) the benefits of an integrated and collaborative multidisciplinary care model for this subpopulation of vulnerable patients.

\u201cOPTIONS-DC\u201d, a feasible discharge planning conference to expand infection treatment options for people with substance use disorder

BackgroundSerious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited.MethodsWe describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options.ResultsFifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations.ConclusionsOPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment.

Battling Over the Harm Reduction Logic in Addiction Services: The Role of Emotions

In this paper, we investigate how actors in the addictions field have been battling over the introduction of the harm reduction logic – principles of addiction services that aim to reduce the adverse effects of drug use while individuals with addictions continue to use drugs. In particular, we give attention to how emotions have played a role in this continuing battle. Through an inductive process, we identified highly emotional dimensions of the harm reduction logic, and focused our analysis on the emotion-based mechanisms employed by proponents and opponents of the harm reduction logic. We observed that during different time periods, principles of harm reduction were alternately strengthened or diminished. Our findings highlight the difficulties in introducing novel approaches to critical health concerns, such as addictions that have significant social implications. Theoretically, we contribute to the literature on institutional logics by focusing on the emotion-based aspect of certain logics, and by explaining how actors can strategically use emotions to strengthen or weaken particular approaches to healthcare concerns.

Service providers\u2019 use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study

BackgroundAlthough abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse.MethodsThematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes.ResultsOur analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers’ description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult’s autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse.ConclusionsHarm reduction approaches are evident in service providers’ accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment.

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06904-4.

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress.

The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one.

Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review.

The purpose of this scoping review was to systematically identify and describe literature that uses a health equity-oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids. To be included, papers had to both: i) use a health equity-oriented approach, defined as a response that addresses health inequities and aims to reduce drug-related harms of stigma or overdose; and ii) include at least one of the following concepts: cultural safety, trauma- and violence-informed care, or harm reduction. We also looked for papers that included an Indigenous-informed perspective in addition to any of the three concepts. An a priori protocol was published and the JBI methodology for conducting scoping reviews was employed. Published and unpublished literature from January 1, 2000, to July 31, 2019, was included. The databases searched included CINAHL (EBSCOhost), MEDLINE (Ovid), Academic Search Premier (EBSCOhost), PsycINFO (EBSCOhost), Sociological Abstracts and Social Services Abstracts (ProQuest), JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, PROSPERO, Aboriginal Health Abstract Database, First Nations Periodical Index, and the National Indigenous Studies Portal. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and targeted web searches. Screening and data extraction were performed by two reviewers using templates developed by the authors. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. A total of a total of 1065 articles were identified and screened, with a total of 148 articles included. The majority were published in the previous five years (73%) and were from North America (78%). Most articles only focused on one of the three health equity-oriented approaches, most often harm reduction (n = 79), with only 16 articles including all three. There were 14 articles identified that also included an Indigenous-informed perspective. Almost one-half of the papers were qualitative (n = 65; 44%) and 26 papers included a framework. Of these, seven papers described a framework that included all three approaches, but none included an Indigenous-informed perspective. Recommendations for health equity-oriented approaches are: i) inclusion of people with lived and living experience; ii) multifaceted approaches to reduce stigma and discrimination; iii) recognize and address inequities; iv) drug policy reform and decriminalization; v) ensure harm-reduction principles are applied within comprehensive responses; and vi) proportionate universalism. Gaps in knowledge and areas for future research are discussed. We have identified few conceptual frameworks that are both health equity-oriented and incorporate multiple concepts that could enrich responses to the opioid poisoning emergency. More research is required to evaluate the impact of these integrated frameworks for action.

Assessing public health messaging about cannabis edibles: perspectives from canadian young adults

In light of the recent legalization of cannabis in Canada, and the prevalence of edibles as a preferred mode of consumption for young adults, there is a need for evidence-based youth-targeted public health messaging on edibles that resonates with this audience. To explore Canadian young adult views on existing public health messaging regarding cannabis edibles, we conducted 8 focus groups with 57 university students ages 18 to 24 (32 women; 25 men). A descriptive qualitative approach was used, informed by the importance of process evaluation. Five main themes/concepts emerged from the focus group discussions. These related to: (1) message tone; (2) type and quality of information; (3) message format and venue; (4) relatability; and (5) spokespeople. Results also revealed that gender influences both reception to spokespeople and the quantity of information desired in educational campaigns. Findings informed five recommendations for future Canadian public health campaigns, including avoiding negative or moralizing messages; providing specific information about edibles and their effects; creating short messages for social media; being cautious when striving to create “relatable” campaigns; and finding spokespeople based on authenticity and expertise. Our findings reinforce the importance of youth input in the creation of such campaigns and suggest that young people are receptive to educational messages aligned with harm reduction principles.

HIV and COVID-19: Lessons From HIV and STI Harm Reduction Strategies.

Purpose of ReviewThis review highlights the intersection of the COVID-19, HIV, and STI pandemics and examines how harm reduction strategies can be applied broadly to controlling a pandemic.Recent FindingsSince the onset of the COVID-19 pandemic, remarkable advances in the understanding of COVID-19 prevention, diagnosis, and treatment have been made at a much faster pace than prior pandemics, yet much more still remains to be discovered. Many of the strategies to control the COVID-19 pandemic mirror those employed to stem the HIV pandemic.SummaryHarm reduction principles used in the HIV pandemic can be applied to reduce the morbidity and mortality of the COVID-19 pandemic through effective prevention, detection, and treatment strategies.

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain.

Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control. Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy. Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring. Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.

Redefining recovery: Accounts of treatment experiences of dependent cannabis users in Nigeria

BackgroundResearch on addiction recovery describes recovery as a process leading to cessation of drug use. Few researchers have explored alternative views of recovery, and the interplay of individuals' agency and social context in the recovery process. This study explored situated understandings of recovery among cannabis users that emphasized process and contingency. MethodsWe conducted the study in Uyo, Akwa Ibom State in Nigeria. Participants were current (street-involved) cannabis users aged 21 to 34 (n = 97), recruited through time-location sampling. The study collected data through in-depth, individual interviews, which study staff transcribed, coded, and analyzed thematically. ResultsParticipants' accounts indicated a quest for treatment as a means of recovery and redemption (i.e., repairing an identity damaged by dependent cannabis use). Relapse affected recovery when participants defined the latter as abstinence. Framing recovery this way showed the effects of social and structural factors on individual agency and treatment experiences. Yet some participants' accounts highlighted a redefinition of recovery as a process (“recovering”), measured by such outcomes as reduced drug use and improved overall well-being. ConclusionsReframing recovery, as some participants' accounts in our study capture, speaks to the need for treatment programs that are informed by the principles of harm reduction and health promotion. Instead of foisting a singular treatment goal defined as total abstinence onto drug users seeking treatment, treatment should be attuned to the experiences and life circumstances of users and support them in achieving their recovery goals.

Principles of Harm Reduction for Young People Who Use Drugs.

In summarizing the proceedings of a longitudinal meeting of experts on substance use disorders among adolescents and young adults, we review 2 principles of care related to harm reduction for young adults with substance use disorders. The first is that harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual's interest or ability to minimize use of substances. The second is that all evidence-based harm reduction strategies available to older adults should be available to young adults and that whenever possible, harm reduction programs should be tailored to young adults and be developmentally appropriate.